March 12, 2010--Heal Thyself
An internist who I know tells me that he can no longer eat in the doctors' lunch room. The food is still good and it remains a welcome place to hide for an hour when busy making rounds in his hospital, but he can't stand the table talk.
"If it isn't about taxes," he confided in me, "with everyone worried that Obama will raise theirs so high that they will no longer be able to practice medicine," as an aside my physician friend quickly adds, "though God knows how paying a little more in taxes would interfere with practicing medicine--these guys, and they are mostly guys, are all making high six figures--if it isn't about that it's about Medicare reimbursements and malpractice lawsuits. I never any more hear them talking about difficult or interesting cases. I even miss the talk about the basketball playoffs and Tiger Woods."
While wondering about how they and we got to this place of hyper self-involvement I received a call from another friend who last week had open heart surgery and was now feeling well enough to welcome visitors. He added, "I also want you to see this place. It's unbelievable."
We picked up some Tropicana, it was a good sign that the juice in the hospital wasn't tasting good to him, and raced right over to see him and it.
And he was right--it is unbelievable.
Nothing but private rooms on the cardiac floor, all arranged in a horseshoe so that the nurses and aides could keep an eye on everything. And they did in a variety of ways--through dimly lit windows into each of the rooms, of course via the latest in telemetry, and through what even to my untutored eye appeared to be an integrated computerized records system. While we visited, in less than an hour the social worker came by to talk about his discharge to a rehab center; a nurses aide came in to take his vitals (and then record them electronically into a computer terminal in his room); the nurse herself looked in to see how he was doing and to remind him that he still hadn't taken his pain medicine (which, when he did, she too duly entered that into the data system); and a dietitian visited to discuss what he wanted for dinner as well as to talk about his diet once he was released and again back on his own.
"Remember," she said with a broad smile, "from now on, Eggs Benedict just once a week. You have to watch your cholesterol and," she playfully tapped his stomach, "your weight. I see you've lost five pounds while you've been with us," she had noticed that on the computer screen, "and I'd like to see you keep it off. So remember, when you're here see Dr. ___ three weeks from now, be sure to come by to visit me so I can keep tabs on you."
He nodded to indicate that he would. "And there will be no charge for that," she said over her shoulder as she danced toward the door.
"I know what you're thinking," my friend said when we were again alone, "This is the way medicine should be practiced. And knowing your proclivities--your political ones I mean--I'll bet you're thinking that after they pass the Obama health care bill this is what everyone will get." He winked at me as he is not much of a fan of President Obama's.
Indeed, I had had exactly those thoughts. "Minimally the computerized record system," I said. "And who knows, if it passes, maybe other things as well. Because you sure are right, this is a terrific place; and in a better world shouldn't more people have treatment and care of this kind? I'll bet," I suggested, "you must have a version of that Cadillac medical insurance they keep talking about."
"Not really," he whispered back at me, his throat had become dry from so much talking, "Only Medicare with AARP supplemental. You just come to this place, and anyone can, and they get reimbursed for whatever is allowed. And from that they treat you this way. You're right, though we don't always agree about the politics about everyone being entitled to getting this kind of care, about that we do agree." Again he winked at me, "And note my use of the word 'entitled.' I'll bet you never thought you'd hear me using that word in this context."
"You're right about that," I said. "It must be your meds messing with your mind. Or should I say, your politics. They can look a little different when you're hooked up to all these monitors." At that he just smiled back at me.
We left shortly after that, feeling very good about how our friend was doing and about the exceptional care he was obviously receiving. And, I couldn't help by think, being on that government program, Medicare, that he can afford!
Later that day, still thinking about our unequal medical system, back down to earth, I thought, while we're waiting for the health care millennium, there are a few things of significance that we can do right now at no or low cost that would make treatment more effective and thereby save some lives. Actually, many lives. Things as seemingly trivial as insisting that all medical personnel wash their hands before touching or treating patients.
There was an article in the New York Times that afternoon on this very subject. (It is linked below.) About Dr. Peter Pronovost, who just published a book about some easy things things that can be implemented that have been proven to make a huge difference in patient care--Safe Patients, Smart Hospitals: How One Doctor's Checklist Can help Us Change Health Care from the Inside Out.
About 31,000 people a year die from bloodstream infections that they contract while in hospitals. Virtually all of these are preventable. For example, catheters are routinely inserted in patients' veins for a variety of reasons and when improperly done lead to serious, life-threatening infections. Dr. Pronovost's checklist includes things doctors and nurses should do before inserting catheters to limit these--wash their hands, clean the skin with chlorhexine, try to avoid placing catheters in the groin, cover themselves and the patient while inserting catheters, and other seemingly commonsense practices that are frequently overlooked or ignored, which in turn lead to infections and, in too many cases, death.
He cites data that shockingly show that medical staff routinely wash their hands only 30 to 40 percent of the time before working with patients and thus infection rates are high. When in circumstances where everyone washed their hands every time and followed his checklist, infection rates dropped to zero. As in none.
We don't have to wait for Congress to act, for more money to be allocated, or for more places to become as smart and caring as my friend's hospital. In the meantime, a little Purell goes a long way. And saves lives.
"If it isn't about taxes," he confided in me, "with everyone worried that Obama will raise theirs so high that they will no longer be able to practice medicine," as an aside my physician friend quickly adds, "though God knows how paying a little more in taxes would interfere with practicing medicine--these guys, and they are mostly guys, are all making high six figures--if it isn't about that it's about Medicare reimbursements and malpractice lawsuits. I never any more hear them talking about difficult or interesting cases. I even miss the talk about the basketball playoffs and Tiger Woods."
While wondering about how they and we got to this place of hyper self-involvement I received a call from another friend who last week had open heart surgery and was now feeling well enough to welcome visitors. He added, "I also want you to see this place. It's unbelievable."
We picked up some Tropicana, it was a good sign that the juice in the hospital wasn't tasting good to him, and raced right over to see him and it.
And he was right--it is unbelievable.
Nothing but private rooms on the cardiac floor, all arranged in a horseshoe so that the nurses and aides could keep an eye on everything. And they did in a variety of ways--through dimly lit windows into each of the rooms, of course via the latest in telemetry, and through what even to my untutored eye appeared to be an integrated computerized records system. While we visited, in less than an hour the social worker came by to talk about his discharge to a rehab center; a nurses aide came in to take his vitals (and then record them electronically into a computer terminal in his room); the nurse herself looked in to see how he was doing and to remind him that he still hadn't taken his pain medicine (which, when he did, she too duly entered that into the data system); and a dietitian visited to discuss what he wanted for dinner as well as to talk about his diet once he was released and again back on his own.
"Remember," she said with a broad smile, "from now on, Eggs Benedict just once a week. You have to watch your cholesterol and," she playfully tapped his stomach, "your weight. I see you've lost five pounds while you've been with us," she had noticed that on the computer screen, "and I'd like to see you keep it off. So remember, when you're here see Dr. ___ three weeks from now, be sure to come by to visit me so I can keep tabs on you."
He nodded to indicate that he would. "And there will be no charge for that," she said over her shoulder as she danced toward the door.
"I know what you're thinking," my friend said when we were again alone, "This is the way medicine should be practiced. And knowing your proclivities--your political ones I mean--I'll bet you're thinking that after they pass the Obama health care bill this is what everyone will get." He winked at me as he is not much of a fan of President Obama's.
Indeed, I had had exactly those thoughts. "Minimally the computerized record system," I said. "And who knows, if it passes, maybe other things as well. Because you sure are right, this is a terrific place; and in a better world shouldn't more people have treatment and care of this kind? I'll bet," I suggested, "you must have a version of that Cadillac medical insurance they keep talking about."
"Not really," he whispered back at me, his throat had become dry from so much talking, "Only Medicare with AARP supplemental. You just come to this place, and anyone can, and they get reimbursed for whatever is allowed. And from that they treat you this way. You're right, though we don't always agree about the politics about everyone being entitled to getting this kind of care, about that we do agree." Again he winked at me, "And note my use of the word 'entitled.' I'll bet you never thought you'd hear me using that word in this context."
"You're right about that," I said. "It must be your meds messing with your mind. Or should I say, your politics. They can look a little different when you're hooked up to all these monitors." At that he just smiled back at me.
We left shortly after that, feeling very good about how our friend was doing and about the exceptional care he was obviously receiving. And, I couldn't help by think, being on that government program, Medicare, that he can afford!
Later that day, still thinking about our unequal medical system, back down to earth, I thought, while we're waiting for the health care millennium, there are a few things of significance that we can do right now at no or low cost that would make treatment more effective and thereby save some lives. Actually, many lives. Things as seemingly trivial as insisting that all medical personnel wash their hands before touching or treating patients.
There was an article in the New York Times that afternoon on this very subject. (It is linked below.) About Dr. Peter Pronovost, who just published a book about some easy things things that can be implemented that have been proven to make a huge difference in patient care--Safe Patients, Smart Hospitals: How One Doctor's Checklist Can help Us Change Health Care from the Inside Out.
About 31,000 people a year die from bloodstream infections that they contract while in hospitals. Virtually all of these are preventable. For example, catheters are routinely inserted in patients' veins for a variety of reasons and when improperly done lead to serious, life-threatening infections. Dr. Pronovost's checklist includes things doctors and nurses should do before inserting catheters to limit these--wash their hands, clean the skin with chlorhexine, try to avoid placing catheters in the groin, cover themselves and the patient while inserting catheters, and other seemingly commonsense practices that are frequently overlooked or ignored, which in turn lead to infections and, in too many cases, death.
He cites data that shockingly show that medical staff routinely wash their hands only 30 to 40 percent of the time before working with patients and thus infection rates are high. When in circumstances where everyone washed their hands every time and followed his checklist, infection rates dropped to zero. As in none.
We don't have to wait for Congress to act, for more money to be allocated, or for more places to become as smart and caring as my friend's hospital. In the meantime, a little Purell goes a long way. And saves lives.
posted by Steven Zwerling at
5:33 AM
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